Provider Demographics
NPI:1629370564
Name:LAMBERT, TIFFANY L (PA-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:LAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1220 NEW SCOTLAND RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9386
Mailing Address - Country:US
Mailing Address - Phone:518-439-4326
Mailing Address - Fax:518-439-6143
Practice Address - Street 1:1220 NEW SCOTLAND RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9386
Practice Address - Country:US
Practice Address - Phone:518-439-4326
Practice Address - Fax:518-439-6143
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105810363A00000X
ALPA.720363A00000X
NY015485363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY05Y3OtherBLUE CROSS BLUE SHIELD
FL003329700Medicaid
FLY05Y3OtherBLUE CROSS BLUE SHIELD